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Risk of Systemic Health Events and Mortality After Vitrectomy for Diabetic Retinopathy in Patients with Type 2
Dane A Jester1, Muhammad Z Chauhan1, Zain S Hussain1
1Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Purpose:
To quantify the risk of mortality, myocardial infarction (MI), stroke, and amputation in patients with type 2 diabetes mellitus (T2DM) who underwent pars plana vitrectomy (PPV) for diabetic retinopathy (DR) compared with those not requiring PPV.
Design:
A retrospective cohort study utilizing the TriNetX US Collaborative Network.
Subjects:
The study included 9081 patients with T2DM who underwent PPV for DR, 363 116 patients with T2DM with DR but no PPV, 92 645 patients with T2DM without DR, and 3 264 709 healthy individuals, all aged ≥18 years.
Methods:
We identified cohorts using specific International Classification of Diseases, 10th Revision and Current Procedural Technology codes. We used propensity score matching to adjust for covariates including age, gender, race, ethnicity, systemic pathology, and ocular conditions unrelated to diabetes.
Main Outcome Measures:
The primary outcome measures were the hazard ratios (HRs) for mortality, MI, stroke, and amputation at 1, 3, and 5 years after PPV compared with the control groups.
Results:
Patients with T2DM undergoing PPV for DR had higher risk of systemic events and mortality. Compared with patients with DR not requiring PPV, the PPV cohort had a higher risk at 1 year for stroke (HR: 1.51; 95% confidence interval [CI]: 1.03, 2.21) and amputation (HR: 1.85; 95% CI: 1.08, 3.16). At 3 years, the risks for MI (HR: 1.44; 95% CI: 1.17, 1.78), stroke (HR: 1.61; 95% CI: 1.25, 2.07), and amputation (HR: 2.17; 95% CI: 1.54, 3.05) were significantly elevated. At 5 years, the risks for mortality (HR: 1.28; 95% CI: 1.13, 1.43), MI (HR: 1.50; 95% CI: 1.26, 1.78), stroke (HR: 1.54; 95% CI: 1.25, 1.91), and amputation (HR: 2.10; 95% CI: 1.58, 2.81) were all significantly higher. When compared with diabetic patients without DR or healthy patients, the PPV cohort faced higher risk of each health outcome analyzed at intervals of 1, 3, and 5 years.
Conclusions:
We found a significant association between patients with T2DM with DR requiring PPV and an increased risk of mortality, MI, stroke, and amputation compared with non-PPV patients with DR, diabetics without DR, and healthy individuals. These findings underscore the need for monitoring and management of systemic health in diabetic patients undergoing PPV for advanced DR.
Financial Disclosures:
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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